Organization
SOUTHRIDGE VILLAGE-CABOT MGNT. CO.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRETCHEN E HUMPHREYS (OFFICE MANAGER)
(501) 362-7023
Entity
Organization
Contact information
Practice address
601 E. MT. SPRINGS ROAD, CABOT, AR 72023
(501) 286-7720
(501) 286-7721
Mailing address
401 SOUTHRIDGE PKWY, HEBER SPRINGS, AR 72543-8853
(501) 362-7023
(501) 362-5214
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
057
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
057
ARKANSAS DEPARTMENT OF HUMAN SERVICES
AR
Enumeration date
06/22/2011
Last updated
06/22/2011
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